小儿单侧斜疝对侧探查846例的评价

Assessment of the contralateral groin in children with unilateral inguinal hernia:report of 846 cases

目的探讨小儿单侧腹股沟斜疝行对侧探查的可行性指征,对降低对侧隐性疝的漏诊率提供方法。方法分析2009年1月至2014年12月期间846例单侧腹股沟斜疝临床资料,根据家属意愿选择不同探查方式,分为开放探查组(76例)与腹腔镜组(770例),比较分析其对侧探查结果,采用SPSS 13.0进行统计学分析,术中对侧隐性疝阳性率、围手术期并发症比较采用χ2检验,P<0.05差异有统计学意义。结果开放探查组76例患儿术前均被发现对侧腹股沟外环口宽松,能容纳成人一右手指以上(直径≥1.2 cm),经手术探查发现对侧隐性疝65例,发生率高达85.5%;腹腔镜组770例中有271例被发现对侧存在隐性疝,发生率为35.2%,差异有显著统计学意义(χ2=71.1,P<0.005)。开放探查组术中3例发生了并发症(3.9%),腹腔镜组有5例发生了并发症(0.6%),两组围手术期并发症发生率比较,差异有统计学意义(χ2=8.03,P<0.01)。结论腹腔镜是诊断和治疗小儿对侧隐匿性腹股沟斜疝的最佳方法。对于无腹腔镜条件者,以外环口扩大作为手术探查的指征,特别是对侧外环口能容纳成人一右手食指尖以上(直径≥1.2 cm)的患儿,其探查意义更高。

Objective To Investigate the feasibility of exploration of the contralateral groin in children with unilateral inguinal hernia in order to reduce the rate of missed diagnosis of contralateral occult hernia. Methods From January 2009 to December 2014, clinical data of 846 cases of unilateral inguinal hernia in our department were analyzed prospectively. According to the parents＇ choice, children were randomly divided into 2 groups： 76 cases in an open exploration group and 770 cases in a laparoscopic exploration group. The resultS of explorations were compared. Statistical analysis was performed by using SPSS 13. 0 software, including comparison of the incidence rate of contralateral occult hernia and perioperative complications by using the Chi-square test. A P value 〈 0.05 was considered statistically significant. Results In the open exploration group, all of the 76 cases had a dilated inguinal outer ring in preoperative physical examination, which could be fitted with the adult right forefinger （ diameter≥ 1.2 cm）. Among them, 65 cases （85.5%） were confirmed to have contralateral occult hernia. In the laparoscopic group, 271 of the 770 cases （35.2%） were confirmed to have occult hernia in the contralateral groin. There was significant difference between the 2 groups in terms of incidence rate of contralateral occult hernia0（2 = 71.1, P 〈0.005）. Three cases （3.9%） in the open exploration group and 5 （0.6%） in the laparoscopic group had complications, with significant difference between the 2 groups （X2 = 8. 03, P 〈 0. 01 ）. Conclusions By using laparoscopy, exploration of contralateral inguinal hernia could be performed safely and effectively, which is considered as the best choice to diagnose and treat the contralateral occult hernia. If laparoscopy is unavailable, dilatation of the outer ring was recommended as a physical sign and suitable indication for contralateral exploration. Especially if the outer ring could be fitted with the adult right forefinger （the diameter≥ 1.2 cm） , the exploration should be highly recommended.